Some reflections on talc poudrage.

We read with interest the well researched article of Stefani et al. [1] about the different techniques of intrapleural talc. This technical paper really filled the gap in our knowledge following established evidences of superiority of the talc itself [2,3] over other products. We have a question and two comments. Could we be provided with data on the size of the talc particles? This intriguing question has its importance in the simple physical fact, that the size of contact surface of the individual particles and their absolute number are probably closely related to the mesothelial reaction created. One can expect, that the poudrage method with its carburettor like permeated cloud-like delivery creates highly homogenous dispersion of the talc particles. Some compare the endoscopic view to the snowfall. On the other hand, the degree of the dispersion in the slurry method depends largely on the time, patience and attention one pays while preparing the mixture. Therefore, while we have a properly standardised method on the poudrage arm, we need more information on the circumstances the slurry was delivered. Instead of disposable gas propelled atomiser one can use a puffer similar to those the beauty industry offers to deliver perfumes. One of us has memories from the early 1990s, when a metal cannister fitted with a rubber ball — called US Army model — was applied in the Frenchay Hospital, Bristol. If somebody cannot afford disposable gas propelled atomiser there is another method to increase the degree of homogenisation of talc particules in the slurry. The idea is stolen from certain nail varnishes where a metal piece serves as homogenisator. Putting small calibre bearing balls into the slurry syringe makes the 1 min shaking more effective. Unfortunately enough, so far we were unable to convince the pharmaceutical industry the usefulness of a kit like this.